If you've been told you might need bunion surgery, the first thing you probably did was start reading — and the first thing you probably found was a wall of terms nobody explained. Osteotomy. Arthrodesis. Lapiplasty. Minimally invasive. Bunionectomy. They all sound like the same thing described five different ways, and none of it tells you what actually happens to your foot.
Here's the straightforward version. There are roughly six categories of bunion surgery, they differ in how much of the bone gets moved and where, and the one you'd be a candidate for depends mostly on how severe your bunion is and whether the joint at the base of your big toe is still healthy. That's it. That's the framework.
Below is a short summary of each type, in plain language, so you can walk into a consultation already knowing what people are talking about.
First, what a bunion actually is
A bunion isn't a growth. It's not a chunk of extra bone that formed on the side of your foot, even though that's exactly what it looks like.
What's actually happening is that the first metatarsal — the long bone leading to your big toe — has drifted outward, away from the other metatarsals. The big toe leans inward toward the second toe to compensate. The bump you see is the head of that metatarsal now sticking out where it doesn't belong. It's a joint misalignment, and it's usually happening in three dimensions: the bone shifts sideways, rotates, and sometimes tilts.
This matters because it explains why the surgeries differ. Every procedure is answering the same question — where do we cut the bone to bring it back into line? — and the answer changes based on how far out of line things have gotten. If you want the fuller anatomy and non-surgical background, our overview of bunions covers what causes them and what can be done before surgery is on the table.
Traditional osteotomy (distal and proximal)
This is the workhorse category and covers most bunion surgeries performed.
An osteotomy means the surgeon cuts the metatarsal bone, shifts the pieces into proper alignment, and fixes them with small screws or pins. The variation is in where along the bone the cut is made.
Distal osteotomy cuts near the head of the metatarsal, closer to the toe. The chevron and Austin procedures are the common names you'll hear. This is used for mild to moderate bunions, because a cut near the end of the bone can only shift things so far before the correction runs out of room.
Proximal osteotomy cuts closer to the base of the metatarsal, back toward the midfoot. Because you're working from the far end of a long lever, a small change at the base produces a large correction at the toe. That makes it the choice for more severe bunions — but it also means a longer stretch of bone needs to heal, so recovery tends to be more involved.
Lapidus procedure and Lapiplasty
The Lapidus is a fusion rather than a cut-and-shift. Instead of repositioning the metatarsal partway along its length, the surgeon addresses the joint at its base — where the metatarsal meets the midfoot — and permanently fuses it in corrected position.
The reasoning: for some people, that base joint is unusually loose, and that instability is what allowed the bunion to form in the first place. Correcting further down the bone leaves the underlying looseness in place, which is one reason bunions can return.
Lapiplasty is a branded, instrumented version of this same concept. It uses specialized guides and fixation hardware designed to correct the bone in all three planes at once, including the rotation that older techniques sometimes left uncorrected. It's frequently marketed as a "3D" correction. The tradeoff is that fusing a joint means giving up a small amount of motion there — motion most people don't consciously use, but it's a real change to the mechanics of the foot.
Minimally invasive bunion surgery
Minimally invasive techniques accomplish a similar bone correction through several small incisions — often just a few millimeters — using a fine burr guided by live X-ray rather than an open view of the joint.
The appeal is real: less soft tissue disruption, smaller scars, and often less post-operative swelling. But minimally invasive isn't a separate correction so much as a different way of delivering one, and not every bunion is suited to it. Severity, joint condition, and bone quality all factor into whether it's appropriate. Techniques in this category continue to evolve, and outcomes depend heavily on the surgeon's experience with the specific method. Our discussion of whether a cosmetic-focused minimally invasive approach makes sense for you goes deeper on the appearance-and-recovery side of that decision.
Bunionectomy (exostectomy)
This is the simplest procedure and the most commonly misunderstood.
A bunionectomy in the narrow sense — sometimes called an exostectomy — removes the prominent bump of bone without realigning the metatarsal underneath it. The bump goes away. The underlying misalignment does not.
Because of that, it's rarely used on its own. It's appropriate mainly for patients whose complaint is purely the bump rubbing against footwear, with no significant deviation of the toe, or for those who aren't candidates for larger reconstructive procedures. When the alignment problem is left uncorrected, the bunion frequently comes back.
Confusingly, "bunionectomy" is also used loosely as an umbrella term for bunion surgery generally. Worth clarifying which meaning is intended when you hear it.
Arthrodesis (joint fusion)
When the big toe joint itself has significant arthritis — cartilage worn down, bone-on-bone, painful through the whole range of motion — realigning it doesn't solve the problem, because the joint surface is the source of the pain.
Arthrodesis fuses the big toe joint in a functional position. The joint no longer moves, but it no longer hurts. Most people walk normally afterward; the main practical limitation is heel height. It's a durable solution for the right patient, typically someone older with advanced joint damage rather than a straightforward alignment issue.
Which one applies to you
The honest answer is that this depends on measurements taken from weight-bearing X-rays — the angle between your first and second metatarsals, the position of the sesamoid bones, the condition of the joint cartilage — plus your age, activity level, and what you need your foot to do.
Two people with visually identical bunions can end up with entirely different recommendations. That's normal.
If you're ready to move from what exists to what fits, our detailed breakdown of which bunion procedure is right for you walks through how those factors get weighed.
And when you want the measurements taken and the options narrowed down for your specific foot, schedule a bunion evaluation at Abacoa Podiatry & Leg Vein Center. You'll get weight-bearing imaging, a clear read on the severity of your deformity, and a direct conversation about which procedures you're actually a candidate for — including the non-surgical options, if surgery isn't necessary yet. Call our Jupiter office to book.